NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Week 10

NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Week 10

Tick, tock, and here we go again. I have been in bed trying to go to sleep for three hours now. I have not gotten more than a few hours of sleep a night in months. My work is being affected and so is my relationship with my wife. She’s over there sleeping like a baby and cannot understand why I can’t sleep. ‘Just close your eyes and relax’, she says. When I close my eyes, all I see is all the work I have to do.

Riley, age 34

Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep and frequently accompany other disorders, especially depression, anxiety, and PTSD. Obtaining a good sleep history is essential to diagnosing sleep disorders, prescribing a treatment plan, and monitoring the plan’s effectiveness. Understanding and managing sleep problems frequently leads to improvement in other mental health disorders that the patient is experiencing.

This week, you will analyze the diagnostic criteria and treatment options of insomnia, hypersomnolence, narcolepsy, sleep apnea, non-rapid eye movement, nightmare disorder, sleep behavior disorder, and other DSM-5 sleep and parasomnic disorders.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 13, “Psychosomatic Medicine” (pp. 465–503)
• Chapter 16, “Normal Sleep and Sleep-Wake Disorders” (pp. 533–563)

Note: This is review from the Learning Resource in Week 3.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 36, “Sleep-Wake Disorders”

Note: You will access this book from the Walden Library databases.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Sleep-Wake Disorders”

Note: You will access this book from the Walden Library databases.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on specific medications, click on The Prescriber’s Guide, 5^th Ed. tab on the Stahl Online website and select the appropriate medication.

Optional Resources

Bélanger, L., Harvey, A. G., Fortier-Brochu, É., Beaulieu-Bonneau, S., Eidelman, P., Talbot, L., . . . Morin, C. M. (2016). Impact of comorbid anxiety and depressive disorders on treatment response to cognitive behavior therapy for insomnia. Journal of Consulting and Clinical Psychology, 84(8), 659–667. doi:10.1037/ccp0000084

Olaithe, M., Nanthakumar, S., Eastwood, P. R., & Bucks, R. S. (2015). Cognitive and mood dysfunction in adult obstructive sleep apnoea (OSA): Implications for psychological research and practice. Translational Issues in Psychological Science, 1(1), 67–78. doi:10.1037/tps0000021

Discussion: Treatment of Sleep/Wake Disorders

The power of sleep to heal the body cannot be underestimated. Most research indicates that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients who come to the PMHNP’s office frequently complain of sleep problems. It is estimated that 10–20% of patients report some type of sleeping problem.

In this Discussion, you will analyze the diagnostic criteria and evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders.

Learning Objectives

Students will:

• Analyze diagnostic criteria for sleep/wake disorders
• Analyze evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders
• Analyze criteria for referring clients to primary care physicians for treatment of sleep/wake disorders
• Compare differential diagnostic features of sleep/wake disorders

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

• By Day 5 of Week 9, your Instructor will have assigned you a sleep/wake disorder, which will be the focus of your original post for this Discussion.
• Review the Learning Resources.

By Day 3

Post:

• Explain the diagnostic criteria for your assigned sleep/wake disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.
• Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.
• Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Week 10.

ADDITIONAL INFORMATION 

Sleep/Wake Disorders and Parasomnias

Introduction

Sleep disorders can be caused by many things, including medications and medical conditions. But they can also be caused by parasomnias, which are unusual behaviors that occur while you’re asleep. Parasomnias are categorized into seven types:

Parasomnias are conditions causing unusual, frightening or dangerous behaviors.

Parasomnias are abnormal behaviors that occur during sleep. They can be terrifying or dangerous and include:

• Sleepwalking

• Sleep talking

• Nightmares

• Night terrors (a type of parasomnia) * Restless legs syndrome (RLS) * Narcolepsy

Sleepwalking and sleep talking.

Sleepwalking and sleep talking are both parasomnias, which are abnormal behaviors that occur during sleep. They can be dangerous if they’re not taken seriously and treated properly. A sleepwalker may walk out of their room, bump into things while walking around, or even fall down stairs while asleep. If you suspect your child has a sleepwalking disorder, check out the tips below for preventing this from happening to your child!

Sleep Talking: This is when people in their dreams talk aloud while sleeping (also called “sleep-related vocalization”). In general, children tend to talk more than adults do—but some people never stop talking once they’ve started up! Some children who have night terrors (see below) will begin speaking loudly in their dreams as well; however these types of vocalizations aren’t necessarily related specifically with having nightmares themselves but rather just being startled awake during REM (rapid eye movement) phase where most people dream normally without realizing what’s happening.”

Nightmares.

Nightmares are dreams that cause you to wake up. They can be caused by stress and anxiety, alcohol or drugs, illness and sleep deprivation.

You may have nightmares because of a traumatic event in your past or present life. You might also have nightmares because of something that happened recently (like an accident) or something that will happen soon (like an exam).

Restless legs syndrome.

Restless legs syndrome (RLS) is a neurological disorder that causes your legs to feel restless, or as if they are moving involuntarily. It can also cause other symptoms like burning or tingling in the legs, cramps, and pain in the feet.

RLS is diagnosed by ruling out other conditions that cause similar symptoms such as sleep apnea and periodic limb movement disorder (PLMD). The doctor will ask you about your symptoms, including any periods of time when they occur more often than usual. You may be asked to keep track of how long they last during the day and night so he can monitor them over time with tests like bloodwork or an electrocardiogram (EKG) tracing when needed.

Sleep terrors.

Sleep terrors are a very common parasomnia. They can occur in adults and children and often cause the person experiencing them to be very frightened, which makes it hard to wake up and even more difficult to get out of bed.

In addition, sleep terrors can cause injury or harm self or others due to being unable to control their limbs during the episode. It’s also possible for sleep terror attacks to occur during any stage of sleep (wakefulness). This is because people with this disorder may have problems falling asleep or staying asleep, which means that when they do fall asleep, they might wake up with no memory of having been dreaming before waking up normally later on that night; this could lead them into another episode where they feel like their body has become paralyzed but know nothing about it happening until later on when someone else mentions something about their actions during those times when they were supposedly unconscious (and therefore unaware).

Narcolepsy.

Narcolepsy is a neurological disorder. It’s characterized by daytime sleepiness, and it can be accompanied by cataplexy (sudden loss of muscle tone) and hypnagogic hallucinations (seeing things while falling asleep). Narcolepsy can also cause people to fall asleep suddenly in response to strong emotions—for example, anger or joy.

Narcolepsy isn’t just a feeling; it’s a chronic condition that lasts your entire life. If you’ve been diagnosed with narcolepsy since childhood, there’s no cure for this disease yet—but treatments are available to help manage symptoms so they don’t disrupt your daily life too much

Nonepileptic (non-sleep) seizures

Non-epileptic seizures (NEDs) are a type of seizure that occurs without the presence of an epileptic seizure. They can affect people who have epilepsy, and they may be difficult to diagnose.

The symptoms are similar to those found in epileptic seizures: sudden muscle contractions, loss of awareness, jerky movements and/or speech problems. NEDs usually occur three times more often than epileptic ones; however, it’s important not to confuse them with sleep or wakefulness disorders!

Some people experience a warning sensation before the onset of their NEDs—for example, feeling hot or cold—but these sensations aren’t always present until after the fact.

Parasomnias can cause your sleep habits to change

Parasomnias are common, but they can cause serious problems for you.

• Parasomnias can disrupt your sleep. If you have a parasomnia disorder, it may be difficult for you to fall asleep or stay asleep. This means that when it comes time for bedtime and wakeup time, there is no way of knowing how much time has passed between those two events—and this can cause confusion and anxiety if one doesn’t know how much time has elapsed between her “normal” morning routine and the schedule she needs in order to function properly during the day (for instance).

• Parasomnias may also cause problems with deep sleep stages: REM (rapid eye movement) sleep–when most dreams occur–or NREM (non-rapid eye movement) sleep; these stages are important because they help our bodies heal after physical activity or stressors like illness or injury; lack thereof results in poor health outcomes such as obesity/diabetes etc…

Conclusion

Parasomnias are not a sign that you’re crazy. They can be scary and disruptive, but they are a common condition that affects millions of people around the world. The good news is that most parasomnias are treatable, and many people live normal lives with them. Most importantly, it’s important to realize that you have options for coping with your symptoms—even if you don’t know what those options might be yet!